Closed Atrium Bipolar Radiofrequency Box Lesion for Concomitant Surgical Atrial Fibrillation Ablation

Background: In patients with atrial fibrillation (AF) undergoing CABG or AVR, many surgeons are reluctant to open the left atrium for surgical ablation. Isolated pulmonary vein isolation (PVI) is often preferred in these patients. However, especially in patients with persistent AF, a box lesion, isolating the whole posterior left atrial wall, might be beneficial. We here describe our initial experience with a closed atrium bipolar radiofrequency left-atrial box lesion.

Methods: Between January and December, 18 patients received the closed-atrium radiofrequency box lesion set concomitant to AVR or CABG procedures. A curved bipolar radiofrequency clamp was introduced from the right-sided pulmonary veins through the transverse sinus to the end of the left-sided pulmonary veins. In case of enlarged atria, the box lesion was completed from the left side. Alternatively, the bipolar radiofrequency clamps were introduced through the transverse and oblique sinus. LAA closure was performed using an LAA clip in all patients. We here investigated technical feasibility, safety, and efficacy of this new concomitant surgical AF ablation approach.

Results: Mean age of patients was 67.7 years; 72% were male. 11 (61.1%) patients with persistent and 7 (38.8%) patients with paroxysmal AF were treated. Creation of a complete box lesion from the right side was possible in 12 patients, while in 6 patients the box had to be completed from the left side. No major ablation-related complications occurred in any of the patients. Successful intraoperative LAA closure was demonstrated by transesophageal echocardiography in all patients. There was no periprocedural stroke and the in-hospital mortality was 0%. Freedom from AF at discharge was 83.3 and 77.7% at mean follow-up of 9.6 /− 3.3 months.

Conclusion: Closed atrium left-atrial box lesion for surgical treatment of AF concomitant to CABG or AVR is safe and technically feasible. This approach allows for complete isolation of the left-atrial posterior wall without necessity for opening of the left atrium.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025